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1 868-9.  J 

CITY  DOCUMENT. 

V 4-  •'  + 

[No.  44.  ;j 

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SMALL  POX 


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CITY  OF  PROVIDENCE: 


REPORT  TO  THE  BOARD  OF  ALDERMEN,  APRIL  26,  1S69 


By  EDWIN  M.  SNOW,  M.D., 


SUPERINTENDENT  OF  HEALTH. 


■'  r ‘-  ■ 

mh 


PROVIDENCE  : 

HAMMOND,  ANGELL  & CO  . PRINTERS  TO  THE  CITY. 

1869. 


'mm 


UNIVERSITY  OF  ILLINOIS 
LIBRARY 


Class 

I 


Book 


Volume 


CENTRAL  CIRCULATION  AND  BOOKSTACKS 

The  person  borrowing-  thi*  mn+Arioi 


CITY  OF  PROVIDENCE. 


In  Board  of  Aldermen,  April  26,  1869. 
Bead  : Whereupon  it  is  ordered  that  the  same  he  received  and  printed  in 
pamphlet  form  for  the  use  of  the  Board. 

SAMUEL  W.  BROWN,  City  Clerk. 


/ 


REPORT. 


Office  of  the  Superintendent  of  Health,  ) 
Providence  April.  26,  1869.  i 

To  the  Honorable  the  Board  of  Aldermen: — 

Gentlemen  : It  seems  to  be  proper  tbat  I should  make  a 
brief  report  to  your  Board,  in  relation  to  the  Small  Pox  in 
the  city,  during  the  past  winter.  Though  we  have  had  very 
few  cases  of  the  disease,  and  no  deaths  from  it,  the  experience 
of  the  last  six  months  affords  a rehnarkable  illustration  of  the 
effects  of  preventive  measures  in  this  disease,  and  also  fur- 
nishes a complete  refutation  of  the  idea,  often  promulgated  by 
those  ignorant  of  the  subject,  that  vaccination  has  lost  its  pro- 
tective power  against  small  pox. 

Within  the  last  six  months,  ending  with  this  date,  the 
small  pox  has  appeared  in  this  city  at  four  different  times,  and 
in  four  different  localities. 

Origin  of  the  Disease.  In  one  instance,  the  disease  was 
brought  from  Milwaukee,  Wisconsin ; in  the  second,  it  was 
contracted  by  a secret  and  unauthorized  visit  to  the  small 
pox  hospital ; in  the  third  instance,  it  was  brought  from  New 
York  city ; and  in  the  fourth,  I have  been  unable  to  discover 
its  origin. 

Localities.  In  one  case,  it  appeared  in  a thickly-settled 
neighborhood  of  foreign  population,  in  a house  occupied  by 
four  Irish  families ; next,  it  appeared  in  a house  occupied  by 
75  to  80  colored  people  ; next,  in  a narrow,  thickly-crowded 
lane  ; and  lastly,  in  the  rear  of  a thickly-settled  street. 


X 


\*).  A A 


4 


VACCINATION  VS.  SMALL  POX. 


Cases  of  the  Disease.  There  have  been  in  all  fifteen  cases  of 
small  pox  in  the  city,  during  the  last  six  months,  of  which  all 
but  four  were  more  or  less  modified  by  previous  vaccination. 
All  were  comparatively  mild,  and  all  recovered. 

PREVENTIVE  MEASURES  USED. 

1.  At  the  first  appearance  of  the  disease  on  Whelden  street, 
in  November,  I visited  the  cases,  and  proceeded  to  vaccinate 
thoroughly  the  whole  neighborhood.  In  connection  with  Dr. 
Ely,  we  visited  the  Public  School  House  near  the  city  line,  in 
North  Providence,  and  the  Catholic  School"  in  that  vicinity, 
several  times,  and  vaccinated  in  all  two  hundred  and  forty-six 
(246)  children  and  others. 

2.  When  the  disease  appeared  in  the  house  on  Front  street, 
occupied  by  colored  persons,  and  also  in  the  other  localities 
named,  I visited  the  places  and  saw  that  every  person  was 
vaccinated  who  was  exposed  to  the  disease,  and  who  had  not 
previously  been  fully  protected. 

3.  The  small  pox  hospital  at  Field’s  Point  has  been  opened 
twice  during  the  winter,  and  there  have  also  been  five  cases 
of  the  disease  in  the  city,  that  were  not  removed  to  the  hospi- 
tal. The  expense  of  the  hospital,  for  the  whole  season,  has 
been  four  hundred  and  twenty  dollars  and  seventy -three  cents 
($420.73). 

4.  I have  endeavored  to  awaken  the  attention  of  the  people 
to  the  importance  and  necessity  of  vaccination,  from  time  to 
time,  by  reporting  in  the  daily  papers,  the  existence  and  loca- 
tion of  all  cases  of  small  pox  that  have  appeared.  This  is  in 
accordance  with  my  uniform  practice,  since  I have  held  the 
office  of  Superintendent  of  Health,  now  nearly  fourteen  years, 
and  the  results  have  shown  tFat  is  a very  important  measure 
for  the  prevention  of  the  disease. 

5.  From  the  first  of  November,  1868,  to  this  date  inclusive, 
we  have  recorded  the  vaccination  of  five  hundred  and  nine 
(509)  persons,  including  those  vaccinated  in  my  office,  and  in 
the  neighborhood  of  Whelden  street,  and  not  including  a con- 


VACCINATION  VS.  SMALL  POX. 


O 


siderable  number  vaccinated  in  different  places  and  not  re- 
corded. During  the  same  period,  six  months  to  this  date,  I 
have  given  seven  hundred  and  eighty  (780)  certificates  of  vac- 
cination to  children  to  attend  the  public  schools. 

6.  I attended  personally  to  all  the  cases  of  small  pox  that 
were  sent  to  the  hospital,  with  the  exception  of  about  two 
weeks,  the  first  of  December,  when  I was  absent  from  the  city. 
I made  twenty -two  (22)  visits  to  the  hospital,  during  the  win- 
ter, besides  numerous  visits  to  cases  in  the  city,  and  to  houses 
for  the  purpose  of  vaccination. 

RESULTS  OF  THE  MEASURES  ADOPTED. 

1.  No  lives  have  been  lost  from  small  pox,  in  the  city, 
during  the  winter. 

2.  Though  the  small  pox  has  appeared  at  four  differ- 
ent times,  during  the  winter,  and  in  four  different  localities, 
it  has  not  spread  in  a single  instance  beyond  the  house  in 
which  it  appeared,  though  they  were  all  in  localities  peculiarly 
favorable  to  its  propagation.  It  is  certain  that  the  vac- 
cination, and  other  preventive  measures  adopted,  were  the 
sole  causes  of  this  remarkable  result.  Without  those  meas- 
ures, there  can  be  no  doubt  that  the  small  pox  would  have 
spread,  more  or  less,  and  would  have  prevailed  in  the  city 
all  winter. 

8.  These  results  in  the  prevention  of  small  pox,  during  tho 
past  winter,  are  not  exceptional ; but  are  in  accordance  with 
our  experience  in  this  city,  during  the  last  fourteen  years. 
During  that  period,  from  1855  to  1868  inclusive,  there  have 
been  only  forty-five  (45)  deaths  from  small  pox  in  the  city  of 
Providence,  and  the  average  population,  for  the  whole  period, 
has  been  more  than  50,000.  This  gives  an  average  of  only 
three  and  two-tenths  (8.2)  deaths  annually  from  small  pox,  and 
is  only  three-tenths  of  one  per  cent,  of  the  total  mortality. 

It  can  be  safely  claimed  that  this  remarkable  exemption 
from  this  loathsome  disease,  for  so  long  a period,  has  been 
wholly  owing  to  preventive  measures,  of  which  vaccination  is 
the  chief,  and  by  far  the  most  important. 


6 


VACCINATION  VS.  SMALL  POX. 


It  should  not  be  forgotten  here,  that  this  city  is  peculiarly 
exposed  to  this  disease,  being  in  connection,  several  times  daily, 
with  New  York  and  Boston  where  the  disease  is  generally 
present,  and  often  fearfully  prevalent.  In  fact,  small  pox  has 
been  brought  to  Providence  from  those  cities  more  than  once, 
and  frequently  several  times,  in  each  of  the  last  fourteen  years. 

General  Remarks. 

1.  Small  Pox  Hospital.  It  will  be  noticed  that  the  expenses 
of  the  small  pox  hospital  amounted  to  $420.73.  This  seems 
to  be  a large  sum  for  the  small  number  of  patients ; but  when 
we  consider  the  localities  from  which  these  patients  were  re- 
moved, and  look  at  the  results  of  their  removal,  it  must  be 
confessed  that  the  opening  of  the  hospital  was  a most  wise 
precaution. 

But  it  is  a wrong,  and  a disgrace  to  the  city  that  we  have 
no  more  convenient  provision  for  patients  with  this  disease. 
Of  the  whole  expense  of  the  hospital,  $420.73,  more  than  one 
fourth,  or  $110.50,  was  for  transportation  of  patients,  provi- 
sions, and  physician  to  the  hospital.  If  we  had  had  a conven- 
ient place,  during  the  past  winter,  where  the  patients  could 
have  been  cared  for  without  extra  expense  for  keeping  house, 
and  for  transportation,  the  whole  expense  would  not  have  ex- 
ceeded one  hundred ‘dollars. 

I always  hesitate  about  sending  patients  to  the  hospital,  on 
account  of  the  distance,  and  the  great  extra  expense,  and  am 
satisfied  that  in  past  years,  I have  sometimes  hesitated  to  the 
injury  of  the  public  health. 

Recent  discoveries  in  the  disinfection  of  small  pox  hospi- 
tals and  clothing,  and  in  the  destruction  of  the  poison  of  the 
disease,  render  it  perfectly  safe  to  have  these  hospitals,  under 
suitable  regulations,  comparatively  near  to  dwelling  houses. 

A suitable  building  could  be  erected,  at  slight  expense,  on 
the  Dexter  Asylum  farm,  and  could  be  supplied  with  food 
and  necessaries  from  the  Asylum,  with  perfect  safety  to  the 
inmates  of  the  Asylum,  and  to  the  people  in  the  vicinity.  Such 


VACCINATION  VS.  SMALL  POX. 


I 

a building  would  be  a most  valuable  auxiliary  in  the  preven- 
tion of  the  disease  in  the  city,  and  would  save  the  city  much 
expense. 

2.  Protective  'power  of  vaccination.  W e often  see  statements 
in  the  public  papers,  that  vaccination  has  lost  its  protective 
power  against  small  pox,  or  that  it  has  run  out,  implying  that 
the  vaccine  virus  has  lost,  either  in  kind  or  in  degree,  some  of 
the  properties  that  it  possessed  when  first  discovered.  On 
account  of  an  unusual  prevalence  of  small  pox,  during  the  last 
fall  and  winter,  in  California,  as  well  as  in  Chicago,  St.  Louis, 
and  other  of  our  midland  cities,  these  statements  in  the  news- 
papers have  been  more  frequent  than  usual.  It  is  probable 
that  there  are  many  persons  in  the  community  who  are  in- 
clined to  believe  them,  or  at  least,  to  think  that  there  is  some 
foundation  for  them.  And  yet  there  is  not  one  particle  of 
truth  in  them.  The  character  and  properties  of  vaccine  virus 
are  as  perfect,  and  its  protective  power  against  small  pox  is  as 
certain  and  effectual,  in  Providence,  to-day,  as  it  was  when  first 
discovered  by  J enner. 

The  proof  of  this  is  seen,  first,  in  the  character  and  effects  of 
the  vaccine  virus  itself ; and  second , in  the  results  of  its  applica- 
tion in  the  community. 

1.  The  vaccine  virus  itself  Dr.  Jenner  gave  minute  in- 
structions for  vaccination ; described  precisely  the  character, 
properties,  and  local  and  constitutional  effects  of  the  vaccine 
virus ; and  gave  a most  exact  and  particular  description  of  the 
progress  and  appearance  of  the  vaccine  vesicle,  day  by  day, 
from  the  insertion  of  the  virus  until  the  scar  is  healed. 

The  operation  done  in  the  same  way,  in  Providence,  to  day, 
produces  precisely  the  same  local  and  constitutional  effects,  and 
the  most  skillful  and  minute,  professional  examination  of  the 
vesicle,  day  by  day,  cannot  discover  the  slightest  variation 
from  Dr.  Jenner’s  description. 

2.  Results  of  vaccination.  The  results  of  vaccination  in  giv- 
ing protection  from  small  pox,  are  precisely  the  same  here 
now,  as  they  were  in  the  time  of  Jenner. 


8 


VACCINATION  VS.  SMALL  POX. 


We  have  already  seen  that,  in  Providence,  during  the  past 
winter,  small  pox  has  been  stopped  four  different  times,  by 
vaccination.  No  one  can  believe  that  if  there  had  been  no  pro- 
tective power  in  vaccination,  the  disease  could  have  been  ar- 
rested under  the  circumstances  in  which  it  appeared.  But 
there  is  more  direct  and  positive  proof  than  this,  of  the  pro- 
tective power  of  vaccination  at  the  present  time. 

During  this  present  month  of  April,  1869, 1 have  had  a case 
of  small  pox  in  a family  where  there  were  three  persons  wholly 
unprotected,  and  one  .other  person  with  only  partial  protec- 
tion. I vaccinated  them  all,  and  though  they  remained  in 
the  family,  and  went  freely  in  and  out  of  the  room  with  the 
small  pox,  until  recovery,  not  one  of  them  had  the  slightest 
symptoms  of  the  disease.  Was  there  any  evidence  of  a weak- 
ened protective  power  of  vaccination  in  that  case  ? And  yet, 
during  this  same  time,  an  article  appeared  in  one  of  our  daily 
papers  taking  the  ground  that  vaccination  had  lost  its  pro- 
tective power  against  small  pox.  But  this  is  no  exceptional 
case.  I have  had  scores  of  similar  cases  during  the  last  four- 
teen years. 

It  may  be  assumed,  positively,  that  the  remarkable  exemp- 
tion from  small  pox,  enjoyed  by  this  city  during  the  last  four- 
teen years,  as  already  described,  has  been  wholly  owing  to  the 
protective  power  of  vaccination. 

The  following  facts,  from  the  experience  of  the  past  four- 
teen years,  furnish  additional  evidence  upon  this  subject: — 

During  the  fourteen  years,  nearly,  July,  1855,  to  April, 
1869,  ten  thousand  four  hundred  and  sixty-four  (10,464)  per- 
sons have  been  vaccinated  in  my  office.  Yery  many  more,  of 
course,  have  been  vaccinated,  in  the  same  time,  by  other 
physicians  in  the  city. 

During  the  same  fourteen  years,  I have  myself  given  certifi- 
cates of  vaccination  to  sixteen  thousand  three  hundred  and 
thirty-two  (16,882)  children  to  enter  the  public  schools.  Prob- 
ably nine- tenths  of  these  certificates  were  given  by  me,  solely 
from  the  evidence  furnished  by  the  vaccination  scar,  and  be- 


VACCINATION  VS.  SMALL  POX. 


9 


cause  I had  full  faith  in  the  protection  furnished  by  vaccina- 
tion against  the  small  pox.  Now  note  the  result ! 

During  these  same  fourteen  years  I have  known  of  nearly 
every  case  of  small  pox  in  Providence,  and  have  visited  the 
greater  portion  of  them  myself,  and  I have  never,  during  this 
time,  seen  or  beard  of  a single  case  of  small  pox  in  any  scholar 
in  tbe  public  schools,  who  had  received  a vaccination  certifi- 
cate. These  facts  certainly  seem  to  prove  that  vaccination 
has  not  lost  its  protective  power. 

But  it  cannot  be  necessary  to  say  more  upon  this  point.  My 
confidence  in  vaccination,  when  properly  performed,  is  so  great 
that  I would  freely  pledge  myself  to  give  any  person,  always 
for  the  time  being  and  generally  for  life,  complete  and  absolute 
protection  against  small  pox,  however  much  exposed. 

The  reasons  why  small  pox  has  been  so  prevalent  in  Califor- 
nia, and  in  some  of  our  midland  cities,  during  the  past  year,  are 
perfectly  well  understood.  They  are  not  because  vaccination 
has  lost  any  protective  power ; but  because  vaccination  has 
been  neglected,  or  imperfectly  applied.  For  the  same  reasons, 
small  pox  is  quite  prevalent  in  New  York  city,  at  the  present 
time,  and  for  the  same  reasons,  we  frequently  have  the  disease, 
though  to  a much  less  extent,  in  this  city. 

Respectfully, 

EDWIN  M.  SNOW,  M.  D., 

Superintendent  of  Health. 


